简介：AbstractObjective:Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning. Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes. The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.Methods:In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, we systematically searched PubMed, Embase, CINAHL, and Cochrane databases. Studies were categorized according to the type of simulation models investigated.Results:We identified 238 unique references, with 55 studies ultimately meeting inclusion criteria. Of these, 19 studies described cadaveric dissection models, 17 discussed three-dimensional (3D) printed models, 14 examined virtual surgical planning and augmented reality-based models, and five 5 articles described task trainers.Conclusions:There are a wide variety of simulation models for endoscopic skull base surgery, including high-fidelity cadaveric, virtual reality, and 3D-printed models. These models are an asset for trainee development and preoperative surgical preparation.

简介：<正>Theskullbasegenerallyreferstotheanterior,middleandposteriorcranialfossaandstructuresontheoutsidesideoftheseskullareas.Thecranialroofandskullbaseareseparatedbyalineconnectingtheexternaloccipitalprotuberance,parietalnotchandsupraorbitalridge[1].Theskullbasesupportsthebrainabove,isconnectedto

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简介：AbstractObjectives:Patients with obstructive sleep apnea (OSA) are at increased risk of perioperative and postoperative morbidity. The use of continuous positive airway pressure (CPAP) in the perioperative period may be of potential benefit. However, among patients who have undergone endonasal skull base surgery, many surgeons avoid prompt re-initiation of CPAP therapy due to the theoretical increased risk of epistaxis, excessive dryness, pneumocephalus, repair migration, intracranial introduction of bacteria, and cerebrospinal fluid (CSF) leak. The objective of this article is to review the most up-to-date literature regarding when it is safe to resume CPAP usage in the patient undergoing endonasal skull base surgery.Data Sources and Methods:This review combines the most recent literature as queried through PubMed regarding the safety of CPAP resumption following endonasal skull base surgery.Results:Recent surveys of skull base surgeons demonstrate little consensus regarding the post-operative management of OSA. Recent cadaveric studies suggest that approximately 85% of delivered CPAP pressures are transmitted to the sphenoid sinus. Further, at frequently prescribed CPAP pressure settings, common sellar reconstruction techniques maintain their integrity while preventing very little transmission of pressure into the sella. In small retrospective case series, patients with OSA who received CPAP immediately following transsphenoidal pituitary surgery had similar rates of surgical complications as OSA patients who did not receive CPAP in the immediate post-operative period. Concerns of reinitiating CPAP too early, such as the development of pneumocephalus, rarely develop.Conclusions:There remains a paucity of objective data regarding when it is safe to resume CPAP following endonasal skull base surgery. Recent cadaveric studies and small retrospective case series suggest that it may be safe to resume CPAP earlier than is often practiced following endonasal skull base surgery.

简介：BACKGROUND:Wedevelopedanimage-guidedrobotsystemtoprovidemechanicalassistanceforskullbasedrilling,whichisperformedtogainaccessforsomeneurosurgicalinterventions,suchastumourresection.Themotivationforintroduc-ingthisrobotwastoimprovesafetybypreventingthesurgeonfromaccidentallydamagingcriticalneurovascularstructuresdur-

简介：AbstractBackground:Endonasal endoscopic skull base surgery has undergone rapid technological developments and is now widely performed, but its strengths and weaknesses deserve further investigation and deliberation. This study was performed to investigate the surgical indications, complications, and technical advantages and disadvantages of endonasal endoscopic skull base surgery.Methods:The clinical data of 1886 endoscopic endonasal skull base surgeries performed in our ward at Beijing Tiantan Hospital from June 2006 to June 2016 were retrospectively analyzed.Results:One thousand ninety-three (73.4%, 1490) pituitary adenomas, 54 (24.9%, 217) chordomas, 28 (80.0%, 35) craniopharyngiomas, and 15 (83.3%, 18) meningiomas underwent total resection. Two patients died postoperatively, both having pituitary adenomas. Other postoperative complications included olfactory disorders (n = 226, 11.9%), postoperative cerebrospinal fluid leakage (n = 78, 4.1%), hypopituitarism (n = 74, 3.9%), diabetes insipidus (n = 64, 3.4%), intracranial infection (n = 36, 1.9%), epistaxis (n = 24, 1.3%), vascular injury (n = 8, 0.4%), optic nerve injury (n = 8, 0.4%), and oculomotor movement impairment (n = 4, 0.2%). In total, 1517 (80.4%) patients were followed up for 6 to 126 months (average, 42.5 months) postoperatively. A total of 196 (13.2%) pituitary adenomas and 13 (37.1%) craniopharyngiomas recurred but no meningiomas recurred. Chordomas recurred in 97 (44.7%) patients, in whom 5-year survival rate was 65%.Conclusion:Endoscopic surgery is an innovative surgical technique and the first choice for most midline extradural lesions such as chordomas, and an excellent choice for pituitary adenomas. It probably will be a good technique for many kinds of craniopharyngiomas and a common technique for most of skull base meningiomas, so the surgical indications of these cases should be chosen carefully to make good use of its respective advantages.

简介：AbstractPediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.

简介：AbstractEndoscopic endonasal orbital surgery is evolving. With increasing knowledge, expertise, and technology, the historical limits of the endonasal endoscopic approach to the orbit have been redefined. This review discusses the clinical presentation and etiology, and highlights the pertinent anatomy, and discusses the diagnostic workup and surgical approach to orbital tumors and post-operative care. The role of the multidisciplinary team is not to be underestimated. The introduction of a classification system to ensure standardization of technical difficulty and outcome data will assist with international collaboration and further consolidate our attainment of knowledge in this developing field.

简介：AbstractObjective:There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ablation. However, when open resection is required, free flap reconstruction is often necessary to provide sufficient well-vascularized tissue for optimal wound healing as well as providing adequate tissue bulk for cosmesis. This articleaims to providea focused review of free flaps most commonly used in anterior skull base reconstruction.Methods:This is a state-of-the-art review based on expert opinion and previously published reviews and journal articles, queried using PubMed and Google Scholar.Results & conclusion:Anterior skull base reconstruction via free tissue transfer is imperative in limiting complications and promoting healing, particularly with large defects, post-radiation, and in at-risk patients. The type of free flap utilized for a particular anterior skull base reconstruction should be tailored to the patient and nature of the disease. This review offers insight into the numerous reconstructive options for the free flap surgeon.

简介：AbstractBackground:Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation.Methods:Literature review of current treatment strategies for chordomas of the skull base.Results:Surgery is the mainstay of treatment and complete resection has paramount importance for prognosis. When complete resection is not achieved recurrent disease is common. The anatomical complexity of the skull base makes resection complex. Endonasal endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be challenging. Evidence suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the disease. Nonetheless, immediate post-operative radiotherapy improves survival. Many strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy, gamma knife surgery, proton beam therapy, and carbon ion radiation therapy. There is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show promise. Several optional molecular targets exist. Brachyury is overexpressed in 95% of chordomas but not in other mesenchymal neoplasms. However, its precise role in chordoma pathogenesis is currently unclear, and its cellular location in the nucleus makes it difficult to target. The inhibition of brachyury in chordoma cell lines induces growth arrest and apoptosis. This does not have clinical application to date. There are retrospective results with different molecular targeted therapies for advanced chordomas with some effectiveness.Conclusion:Despite improvements made in the past 10 years in our knowledge of chordoma biology, available therapies still offer a limited benefit. There is an unmet need for new therapeutic options for patients with advanced disease. Therefore, patients with advanced disease should be encouraged to participate in clinical trials when and where available.

简介：ObjectivesConventionalapproachesforremovaloflateralskullbasetumors,includingtransmandibular,infratemporalfossa,preauriculartranszygmaticsubtemporalapproaches,aremajorinvasiveproceduresthatoftensacrificehearingandcauseabnormalocclusionandcosmeticdefects.Reportsofthetranscervicalapproachforresectionofskullbasetumorsarerare,althoughitwasdescribedforresectionofclivalchordomasinasearlyas1966.Thepurposeofthisstudyistoreviewourexperiencesinmanagementoflateralskullbasetumorsusingthetranscervicalapproach.StudyDesignRetrospectivechartreview.MethodsSixlateralskullbasetumorcasestreatedwithtranscervicalapproachprocedureswerereviewed,includingthemedicalrecords.ResultsTherewere4malesand2females.Agerangedfrom12through52years.Histopathologicaldiagnosesincludedmalignantschwannoma(n=1),malignantcarotidbodytumor(n=1),heamangioma(n=1),schwannoma(n=2)andpleomorphicadenoma(n=1).Transcervicaltechniqueswereusedinallcaseswiththeuseofmicroscopeinthelateralskullbasearea.Completetumorremovalwasachievedinallcases.Postoperativeradiotherapywasimplementedin1caseofmalignantschwannomaand1caseofmalignantcarotidbodytumor.Jugularforamensyndromeoccurredasasurgicalcomplicationin1caseofmalignantSchwannomaofthevagusnerve.Therewasnotumorrecurrenceduringthe10-42monthfollow-upperiod.ConclusionComparedwithconventionalapproaches,thetranscervicalapproachprovidesaeasy,safe,minimalinvasiveandeffectiveprocedureforremovalofselectedlateralskullbasetumors.

简介：AbstractThe contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

简介：AbstractBackground and objective:Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.Methods:The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.Results:In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.Conclusion:Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

简介：AbstractObjective:To evaluate the necessity and effectiveness of a preplanned technique for drilling during transcanal endoscopic ear surgery.Methods:Study design: Retrospective case series study from June 2011 to June 2015. Setting: Private tertiary care hospital. Patients: Eighty-five ears of 78 patients, age ranging from 9 to 57 years underwent transcanal endoscopic drilling for various types of pathology in their middle and external ear. Interventions: Application of a preplanned technique for transcanal drilling in endoscopic ear surgery that involved short timed drilling with use of intermittent irrigation and suction. Every events of the procedure were done one after another with the single hand of the surgeon. An attachment providing protecting sheath around rotating burr was used during each time of drilling. Main outcomes measure: Efficacy of such drilling technique in single handed endoscopic ear surgery. Presence of any postoperative thermal injury of facial nerve and any lacerated injury of skin of external ear.Results:This preplanned technique was found suitable for transcanal endoscopic drilling with the single hand of the surgeon. Postoperative facial nerve palsy or laceration of skin of external ear was not noted in any patient.Conclusion:After using the present technique, transcanal endoscopic drilling could be done easily and safely with single hand of the surgeon.

简介：BackgroundComparedwiththeopensaphenousveinharvesting(OVH),thereisalargerdecreaseinincisioncomplicationsofendoscopicveinharvesting(EVH).Fewerstudieswereconductedtoevaluatethequalityofgreatsaphenousvein(SVG)harvestingbythesetwomethods.Toapplytransittimeflowmeasurement(TTFM)toSVGgraftsincoronaryarterybypassgrafting(CABG),weproperlyevaluatethequalityofSVGandsurgicaleffect.MethodsFromJanuary2012toAugust2012,38casesunderwentEVHand16casesunderwentOVH.Werecordedpulsatilityindex(PI),meangraftflow(MGF)anddiastolicflow(DF)ofSVGgraftsforstatisticalanalysis.ThedysfunctionalgraftsdiagnosticcriteriaisPI>5,MGF<10mL/minorDF<50%.ResultIntermsofSVGgrafts,nosignificantdifferenceexistedinthelengthoftwogroups(P=0.2395).EVHgroupharvestingtimewaslongerthanOVHgroup(P=0.0113),buttheincisionlengthofEVHgroupwasshorter(P=0.0000)anditneededlesssuturetime.EVHgrouppresentednosignificantdifferencesinincisioncomplicationratefromOVHgroup(P=0.7055)within1monthaftersurgery.TTFMdataofwellfunctioninggraftshadnosignificantdifferenceinthetwogroups(PI3.2±1.0vs.2.9±0.9,MGF34.7±20.4vs.36.3±19.2mL/min,DF66.3%±10.6%vs.68.5%±10.3%).Therewasnosignificantdifferenceintherateofdysfunctionalgraftsintwogroups(P=0.7954)aswell.Thecausefordysfunctionalgraftsisanastomoticstricture.Were-anastomosedthegraftswithsatisfactoryeffect.ConclusionEVHisasafeandrecommendableoptionalSVGharvestingmethods.ThesurgicaleffectandthequalityofSVGgraftscanbereasonablyevaluatedbyTTFM.

简介：AbstractObjective:Endoscopic approaches for sinus and skull base surgery are increasing in popularity. The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery (EES), highlight preventative measures, and illustrate key management principles.Data Sources:Comprehensive literature review.Methods:Relevant literature was reviewed using PubMed/MEDLINE.Results:Carotid artery injury in EES is rare, with most studies reporting an incidence below 0.1%. Anatomic aberrancies, wide dissection margins, as well as specific provider and hospital factors, may increase the risk of injury. Multidisciplinary teams, comprehensive preoperative imaging, patient risk assessment, and formal training in vascular emergencies may reduce the risk. Management protocols should emphasize proper visualization of the injury site, fluid replacement, rapid packing, angiography, and endovascular techniques to achieve hemostasis.Conclusions:While EES is a relatively safe procedure, carotid artery injury is a devastating complication that warrants full consideration in surgical planning. Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging. Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.

简介：AbstractObjective:To describe and assess the repair technique and perioperative management for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.Methods:This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020. Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study. The data of medical and radiological records, surgical approaches, repair techniques, peritoperative management, surgical outcome and postoperative follow-up were analyzed. Surgical repair techniques were tailored to the condition of associated injuries of the scalp, bony and dura injuries and associated intracranial lesions. Patients were followed up for the outcome of CSF leak and surgical complications. Data were presented as frequency and percent.Results:Thirty-five patients were included in this series. The patients’ mean age was 33 years (range 11-71 years). Eight patients were treated surgically within 2 weeks; while the other 27 patients, with prolonged or recurrent CSF rhinorrhea, received the repair surgery at 17 days to 10 years after the initial trauma. The mean overall length of follow-up was 23 months (range 3-65 months). All the patients suffered from frontobasal multiple fractures. The basic repair tenet was to achieve watertight seal of the dura. The frontal pericranial flap alone was used in 20 patients, combined with temporalis muscle and/or its facia in 10 patients. Free fascia lata graft was used instead in the rest 5 patients. No CSF leak was found in all the patients at discharge. There was no surgical mortality in this series. Bilateral anosmia was the most common complication. At follow-up, no recurrent CSF leak or meningitis occurred. No patients developed mucoceles, epidural abscess or osteomyelitis. One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus.Conclusion:Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach. Vascularized tissue flaps are ideal grafts for cranial base reconstruction, either alone or in combination with temporalis muscle and its fascia—fascia lata sometimes can be opted as free autologous graft. The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.

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简介：DearSir,IamDr.Yin-HungChangfromtheDepartmentofOtolaryngology,TaipeiTzuChiHospital,theBuddhistTzuChiMedicalFoundation.Iwouldliketopresentacaseofinvertedpapillomawithcarcinomachangeoflacrimaldrainageapparatusandnasalcavitythathadbeensuccessfullytreatedbyendoscopicsurgery.Lacrimaldrainageapparatustumorsarerarebutimportant

简介：BackgroundSpinalpainisaserioushealthandsocial-economicproblem.Endoscopicspinesurgeryasatreatmentoptionforspinalpainhasgainedtremendousattentionandgrowthinthepast2decades,andavarietyofendoscopictechniqueshavebeeninventedtotreatawiderangeofspinalconditions.PurposesThepurposesofthis2-partreviewarticleareto1)overviewthepublishedtechniquesofendoscopicspinesurgery,2)summarizetheapplicationsofthesetechniquesintreatingvariousspinalconditions,and3)evaluatetheclinicalevidenceofthesafetyandeffectivenessoftheseendoscopictechniquesintreatingsomeofthemostcommonspinalconditions.Thefirstpartofthereviewarticleprovidesanoverviewofcurrentlymostcommonlyusedtechniques.MethodsWesearchedthePubMeddatabaseforpublicationsconcerningendoscopicspinesurgeryandreviewedtherelevantarticlespublishedintheEnglishlanguage.ResultsDiscectomyandforaminotomyarethemostcommontypesofspinesurgerythatcancurrentlybedoneendoscopically.Endoscopictechniqueshavebeenusedtotreatawiderangeofspinaldisorderslocatedinthelumbar,cervical,aswellasthethoracicregionsofthespine.